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The Menopause

While the phase of feminine sexual life which involves the cessation
of menstruation is physiological and not morbid, it is so commonly
associated with physical and mental symptoms difficult to bear that,
practically always, it sends the woman to a physician. This is as true
of the artificial menopause induced by removal of ovaries as it is of
the normal process by which, in the course of time, ovarian function
comes to an end and changes are brought about in the system consequent
upon the absence of ovarian secretion. The ovaries, like many other
organs, have two functions. One, that of ovulation, is so prominent
that the other, the internal secretion, has been too much neglected.
How important this is, however, may be judged from the change that
comes over feminine nature after its cessation. Much of the
emotionality of woman disappears, not a few of her special sex
qualities are modified and even masculine physical peculiarities may
assert themselves. The physical effects of the ovarian internal
secretion may be inferred from the definite tendency to grow stout
which results from its suppression by the menopause. Certain changes
in the organism are inevitable then, and the only hope of therapy is
to keep them from disturbing life processes.

Neutralizing Unfavorable Mental Attitude.--Psychotherapy can do more
for the troubles of the menopause than any other treatment. The
symptoms of the change of life in the long ago, if we can trust
traditions, were not so troublesome as they are now. Only rarely did
women suffer from it as they are supposed to suffer at the present
time. Women are so persuaded that there is to be much suffering, or at
least prolonged physical discomfort, as to make it difficult for them
to be quite themselves. They are prone to think that their physical
symptoms are noted, and that their condition is a subject of remark.
This adds to the difficulty of bearing in patience whatever symptoms
are present. The introspective attitude of our time has reacted upon
such affections as occur in the menopause, and, by creating an
abnormal susceptibility of mind, has added much not only to its
possibility but also to its actuality of suffering. Drugs or other
remedial measures will modify the conditions only partially and
temporarily. The mental prophylaxis of suggestion must alter the state
of mind both before and during the progress of the condition.

Favorable Suggestion.--After the menopause women are less disturbed by
emotional strains and troubles of any kind than before. They settle
down into more placid, easy-going lives. They are not subjected to the
monthly interruption of their routine of work or amusement, everything
comes a little easier to them, and they are not, to use the word in
its physiological sense, so irritable--that is, so responsive in
reaction. They are not so likely to respond to slight irritations, and
are often physically and mentally more content with life. This must be
insisted upon, for, at the present time, unfavorable suggestion with
regard to the menopause is the universal rule. Women look for the
worst from it, and their expectation makes conditions less tolerable
than they really are. Most women dread it as if it were the beginning
of the end of life, the first descent into old age, while it is often
the dawn of a larger and broader life free from sexual and other
irritations, and with better possibilities of accomplishment.

Definite Prescriptions.--These patients are best reassured by being
told that every woman who has lived to the age of fifty has gone
through a similar experience and that they have all, with rare
exceptions, revived with health of both body and mind. It is more
important to insist on the patients cultivating a certain gaiety of
disposition, to plan for regular diversions two or three times a week,
to see that they are not too much alone and that they find abundant
occupation of mind and body, than to try to combat their manifold
symptoms by drugs or local measures. Of course, their physical
functions must be kept normal. It is surprising, however, how much
improvement can be brought about in the menopause symptoms by definite
prescriptions as to the time to be spent in the open air--at least two
or three hours a day--with regard to having a definite diversion of
some kind in mind two or three days ahead to which they look forward
with pleasure, and by convincing them that whenever they allow
themselves to dwell much on their condition, their symptoms of
discomfort will become so severe as to be intolerable, while when they
are occupied with other things they will find them quite easy to bear.

As a rule, mothers of families with many cares and diversions of mind,
with little time to think of themselves, do not suffer much at this
period, or at least not nearly so much as do those who are without
these diversions. The more time a woman has to think about herself at
this period, the worse for her. Her irritability of mind will be
reflected upon her physical condition and make it worse. In the olden
time mothers of families went through it and no one knew about it, or
even noticed that there was anything the matter with them except
possibly a little increased irritability at certain periods. Neither
menstruation nor the menopause is necessarily connected with more than
passing discomfort, if the patient is in good health. This is
perfectly true if symptoms are not brooded over, if there is not too
much expectancy of evils, and the feelings and manifestations which do
not deserve the name of symptoms are taken as a matter of course. Best
of all, let the woman keep her mind well occupied with many
duties--with care for others, the helpless, the ailing, around her,
instead of with herself and her passing ills.

Dread of Insanity.--There are few women who go through this period
without the hideous thought that possibly they may go crazy. This is
especially likely if, as a consequence of the exaggerated desire for
seclusion that many women have at this time, they do not get out into
the air nor exercise as much as they should. As a consequence, they
suffer from constipation, from lack of appetite, and capriciousness of
taste for food, and they may have a series of symptoms that, when
dwelt on during the hours of solitude, very seriously disturb the good
feeling that is so important for the normal accomplishment of
physiological functions.

Diversion of Mind.--This tendency to withdraw from social relations
with their friends and from the occupations that take them out of
doors and which are often a helpful diversion of mind is one of the
worst symptoms of this time and must be strenuously combated. It
superinduces a series of physical symptoms which are attributed to the
menopause but are really due to lack of air, to inactivity, to absence
of interest and the consequent opportunity provided for unfortunate
auto-suggestion and introspection. These superadded physical symptoms
can be readily relieved by directions for rational living and then the
genuine menopause symptoms may be so diminished as to be scarcely
noticeable. It is impossible for the ordinary human being to stay much
in the house, to lie down a large part of the time, eat irregularly
and let the bowels become sluggish without having many symptoms of

Summary of Treatment.--The treatment, not of the menopause but of the
patients passing through the menopause, then, must consist, first, in
putting them in as good physical condition as possible and keeping
them in it; second, in maintaining such normal natural habits of life
as will enable them to keep up this physical condition without
disturbance; thirdly, in putting off solicitude with regard to the
menopause and realizing that it is a normal natural process with a
definite place in human life and not at all representing a terminal
stage of human existence. Nature meant that the mature woman, formed
by precious experience, with sympathies broadened by years, should be
able to devote herself without sexual irritation to the many things
that naturally come to her at this period. There is a place in life
for the grandmother and even for the grandaunt, though a French
visitor recently declared that he thought there must be no
grandmothers in America since all the women seemed to dress in the
fashion of the young girl. If this submission to natural conditions is
recognized and accepted there are long years of happiness and
helpfulness in store for the woman of middle age and the menopause may
be welcomed as an important step towards a larger development of life.

Next: Suggestion In Obstetrics

Previous: Menorrhagia

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